Abdominoperineal Resection in South Africa

Abdominoperineal resection (APR) is a type of a surgery in which the anus, rectum, and sigmoid colon are removed through small cuts in the belly. It is a surgical procedure done primarily to remove the cancer of the rectum. Typically, abdominoperineal resection (AP) is conducted as an elective procedure. This procedure is most often used to treat rectum cancer if it is located very low in the rectum or in the anus, close to the sphincter muscles.

Nowadays, advanced surgical techniques and other treatment modalities have brought an increase in the rate of sphincter-sparing operations. However, APR surgery is still necessary in selected cases, especially if the patient has distal tumors or poor sphincter function.  AP resection is a major operation. During perineal resection, the rectum, distal colon, and anal sphincter complex are completely removed using both anterior abdominal and perineal incisions. Once the anus and rectum are removed, a permanent colostomy is needed to complete the procedure.

Colostomy brings the colon to an opening at the surface of the skin, which allows the waste to pass out of the body. This new opening is called stoma and usually measures from one to one-and-a-half inches in diameter. A pouch, or a stoma appliance, is needed to be worn at all times. The stoma has no sphincter muscles, so there is no conscious control over the elimination of waste products from the body after the procedure.

• APR surgery starts with the administration of general anaesthesia. This ensures that patient remains asleep during the perineal resection.
• Then the surgeon makes a small cut near the belly button and inserts a laparoscope. A laparoscope has a tiny camera on one end. It is inserted through the cut so so that the inside can be seen.
• Once the laparoscopic camera is in the abdomen, the surgeon makes two to five more small cuts in the abdomen.
• Surgical instruments are inserted through ports placed on these cuts.
• The surgeon completes several steps before removing the rectum, anus, and sigmoid colon.
• The surgeon releases the sigmoid colon and rectum from their attachment to the surrounding structures after dividing the main blood vessels that serve the tumour sections of the bowel.
• The sigmoid colon is separated from the remaining large intestine after the separation.
• After the sigmoid colon and rectum are removed, the surgeon operates perineal region to cut away the anus.
• Finally, the anus, rectum, and sigmoid colon are completely removed from the body.
• After perineal resection, the surgeon creates the stoma. It is known as a colostomy. The stoma is made from one of the surgical cuts usually placed on the left side of the abdomen.

• To create a stoma, the surgeon removes a small disk of skin from the area around the cut.
• The open end of the colon is pulled through the cut on the surface of the skin.
• The surgeon then stitches the stoma in the place and the abdominal cavity is rinsed out.
• A small drainage tube is inserted into one of the lower surgical cuts. This drainage tube will promote healing of the tissue inside the abdomen.
• Finally, the surgeon carefully inspects inside the abdominal cavity and the stitches are used to close the cuts.

Recovery of the patient depends on individual circumstances and general health of the patient. A patient may be required to stay in the hospital for three to seven days. However, some patients may need more time to recover.

You can walk and stand on the first day after AP resection and resume most of the usual activities shortly after the surgery. In fact, increased activity reduces the risk of blood clots and also improves breathing. A physical therapist will often visit you during your hospital stay and will help regain your strength after the surgery. After getting discharged from the hospital, avoid lifting more than 5 to 10 pounds for 4 weeks, as this allows the incisions to heal. It also decreases the risk of developing a hernia.